Provider Demographics
NPI:1245672203
Name:SURRATT, SARA ELIZABETH (MS, CFY-SLP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ELIZABETH
Last Name:SURRATT
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 FAIRWAY DR APT 5
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-5070
Mailing Address - Country:US
Mailing Address - Phone:217-206-5213
Mailing Address - Fax:
Practice Address - Street 1:1010 W NORTH ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:IL
Practice Address - Zip Code:62640-1061
Practice Address - Country:US
Practice Address - Phone:217-627-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002660235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist